Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 00203703 | CO |
NPI | 1639657265 |
---|---|
Provider Name | Dr. Jeffrey I De Guzman |
First Address | Denver, CO 80220-1515 |
Second Address | Denver, CO 80220-1515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2018 |
Last Update Date | 21/08/2020 |